TY - JOUR
T1 - End-of-life practices among tertiary care PICUs in the United States
T2 - A multicenter study
AU - Meert, Kathleen L.
AU - Keele, Linda
AU - Morrison, Wynne
AU - Berg, Robert A.
AU - Dalton, Heidi
AU - Newth, Christopher J.L.
AU - Harrison, Rick
AU - Wessel, David L.
AU - Shanley, Thomas
AU - Carcillo, Joseph
AU - Clark, Amy
AU - Holubkov, Richard
AU - Jenkins, Tammara L.
AU - Doctor, Allan
AU - Dean, J. Michael
AU - Pollack, Murray
N1 - Funding Information:
We acknowledge the contributions of the following individuals: Teresa Liu, MPH, CCRP; University of Utah; Jeri Burr, MS, RN-BC, CCRN, University of Utah; Jean Reardon, MA, BSN, RN, Children’s National Medical Center; Aimee La Bell, MS, RN, Phoenix Children’s Hospital; Margaret Villa, RN, Children’_astr Hospital Los Angeles and Mattel Children’s Hospital; Jeni Kwok, JD, Children’s Hospital Los Angeles; Ann Pawluszka, BSN, RN, Children’s Hospital of Michigan; Monica S. Weber, RN, BSN, CCRP, University of Michigan; Alan C. Abraham, BA, CCRC, University of Pittsburgh Medical Center; Mary Ann DiLiberto, BS, RN, CCRC, Children’s Hospital of Philadelphia; Chris Feudtner, MD, PhD, MPH, Children’s Hospital of Philadelphia.
Publisher Copyright:
© 2015 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.
AB - Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States. Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013. Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network. Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions: None. Measurements and Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed. Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.
KW - autopsy
KW - death
KW - end-of-life care
KW - organ donation
KW - pediatrics
UR - http://www.scopus.com/inward/record.url?scp=84956941213&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000000520
DO - 10.1097/PCC.0000000000000520
M3 - Article
C2 - 26335128
AN - SCOPUS:84956941213
VL - 16
SP - e231-e238
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
SN - 1529-7535
IS - 7
ER -